One constant that I’m finding in a lot of cases from low back pain to shoulder and neck pain is the decreased mobility of the ribs and mid/upper back portion of the spine. The body is intended to maintain some movement in this area, and in it’s absense, can produce symptoms above and below in the shoulder/neck and low back area. As we breath in and out, lean forward, back, side to side and rotate, the ribs will move in relation to each other and the vertebrae of the spine will move in relation to each other. There are several reasons that these areas can stiffen up from immobility of the area, trauma, surgery or past illness (perhaps bronchial or cardiovascular).
The body should be likened to a tree. A tree from the trunk up to the very top has the ability to be flexible along to entire length (obviously more flexible than other areas) but this flexibility is what helps it be strong so when a wind comes up, the forces are distributed along the entire length, so (unless there is an extremely strong wind) it should maintain it’s integrity. Now imagine that you put a metal collar around the middle 2/3d’s of the tree and not allow that portion to flex and reintroduce the wind to the tree. In the absence of the flexibility of the middle 2/3rd’s of the tree, the part of the tree just below now is having to bear the burden that the middle 2/3rd should be doing. The chance of the tree breaking just below the collar increases. Obviously, we will not “break” like a tree but in our instance, the forces inposed on the lower back in absence of good movement in the ribs and mid back will be present.
A person may have very tight shoulders that are pulled forward and a very stiff middle back. When I ask if they can pull their shoulders back, most of the movement involves arching at the lower back to bring the shoulders back. The lower back is an important area and needs to be kept in a neutral position while in a static position as well as movements but is often asked to move out of it’s optimal position to compensate for things like stiff mid back/ ribs or stiff hips.
An area that has become stiff is very difficult often to become aware of as the body is very good at compensating. Personally, I have had an issue with low back pain. My biggest improvement occurred when I worked on mobilizing my ribs, middle and upper back and increased my hip range of motion. Both my hips didn’t extend (move back) very well and my left hip didn’t turn inwards very well and my low back was doing that work. There is only up to 20 degrees of rotation available in the low back so it needs to be used sparingly and shouldn’t be used making up for lack of movement in other joints.
Part of my job is to ensure good movement in the joints that are lacking to the degree that the patient is able to maintain the proper range of motion at home with stretching. Often the less mobile joint is stuck enough that my work is needed to get it going to the point that the patient can maintain it’s flexibility at home.
The second part of the process is often harder and involves the patient being aware now that the joint or body part is now mobile and integrating it into their functional movements such as turning or picking something up or simply walking. A home exercise may be something as simple as sitting and placing your hands on the sides of your abdomen and turning but not allowing your hands to move so that all your movement is in your mid back, just to get the person used to being able to move through the midback.
Each case is different but the philosophy remains the same in that a body’s stability depends very much in it’s systemic flexibility and any rigidity can produce instability.